Fraud webinar - Prevention & Risk Management

Copyright © 2011 MarkLogic® Corporation. All rights reserved.Slide 1
Today’s Webinar
Gov’t CTO
MarkLogic
Chris Biow
Digital Media Specialist
MarkLogic
Diane Burley
Principal Technologist
MarkLogic
Fernando Mesa
Prevention & Risk Management
What you can learn from intelligence agencies
#MarkLogic

Challenges in Government Intel
Extreme Data — Gartner term for:
§ Multiple data sources, schemas
§ Security & privacy concerns
§ Many languages & standards – not all western
§ Rapidly changing information
§ Need for real time updates
§ Many different constituencies for information – each wanting data
presented “the right way”
§ High stakes of failure
Sound familiar?

Mission Accomplishment in Gov’t
§ Combine and provide information on known threat persons
§ Identify threats recorded within large feeds of sensor data
§ Intelligence analysis of enriched Open Source information
(OSINT)
§ Expose insider threat
§ Consolidate all sources of land-use information, including
unstructured
§ Enable secure sharing and discovery of sensitive information
§ Open government information to the public
§ Enable cyber defense by tracking all IT assets
Time to “Mission” / Market

Pressure for Real-Time
§ Radically reduced human
effort
§ Time to first capability
§ 1/3 the time
§ Weekend
§ Fast, progressive refinement
§ Ease of development
§ Ease of maintenance
§ Breadth of requirements
§ Combining sources
§ Consistent view
§ Reduced machine effort
§ Zero latency analytics
§ More data per server
§ Scalable cloud of servers
§ Alerting
Time to Mission System Response Time

Time can be on your side
Changing the way we deliver information.
Design Develop
Add new
data sources
Load data
Time
Traditional
approaches

Real-time Alert
§ Ordinary search/query
§ Save and index the documents/records
§ Run a query
§ Get the result docs/recs
§ Alerting
§ Save and index the queries with related actions
§ Event: alert
§ Criterion: annotation
§ Relationship: connection
§ Destination: routing
§ Run a new document/record
§ Get the matching queries
§ Perform their actions
The other facet of MarkLogic in Real Time

Why MarkLogic for Intelligence
§ Universal Repository – XML at its Core
§ Relational data
§ Hierarchical data
§ GIS
§ Text
§ Fast Access to Information – Search Engine
§ We Index Everything
§ Nothing our customers have seen runs faster
§ Can you use Google?
§ An Interface our Customers Choose
§ Our Application Interface lets you connect to your systems or
§ Use our own front end

Federal HC Data Concerns
§ Extremely disparate formats
§ Vast number of data domains
§ Difficult to transform, merge and manipulate
§ Time crunch
§ Many proprietary standards (and multiple
versions)
§ Difficult to manage and audit
§ Error ridden

Where MarkLogic Helps in Fraud
§ Data Integration Resource
§ Single Client View
§ MMIS Data & other Social Services Resources
§ GIS Integration
§ Complex Security Support (ala HIPAA)
§ Information Sharing Platform
§ Social Media friendly
§ Expose the information you want

Fraud in the Commercial Sector
§ Life Sciences
§ Off-label sales and marketing
§ Health Insurance
§ Social Network Analysis for Fraud Detection
Uses cases in Fraud, Waste and Misuse

Off-label Sales and Marketing
Characteristics
§ Integrate Extreme data
§ Rapidly changing information
§ Complex Analytics
§ Real time monitoring
§ Expose in unique ways (custom)
§ High stakes of failure
Analyzing, monitoring and reporting on internal fraud

Correlate different points of information

Monitor & Alert on Suspicious Patterns

Monitoring off-label practices:
Business Outcome
§ Increase Compliance
§ Monitor and expose deviations in prescription patterns that may be
attributed to illegal sales or marketing activities.
§ Fewer human resources
§ The system can reveal commonalities among thousands of cases,
identifying potentially suspicious activities that the human eye
would miss.
§ Increase Revenue
§ Using the same technology the system can monitor and alert
against fraud but also can spot trends in market usage from the
correlation and analysis of company, web and social data.
Why it matters to your business

Healthcare Claims Fraud
§ Social Network Analysis –
§ MINE social network content from publicly available sites & health
insurance claim information.
§ CORRELATE internal & external data (both structured and
unstructured) to detect possible fraud, abuse and unnecessary
overuse.
§ Uniquely COMBINE repository, monitoring, analytics and presentation
capabilities, to identify potentially fraudulent and abusive behavior
before a claim is paid or, retrospectively, analyze providers' past
behaviors to flag suspicious patterns.
Social Network Analysis for Fraud detection

Social Network Analysis

Best Practices
§ Flexible integration should be at the core
§ Complete Analysis is near impossible without the ability to ingest
easily disparate data sources: relational, hierarchical, GIS, Text.
§ Design for the unpredictable
§ Information changes fast, so do the questions that the system
needs to answer. Best to build a platform with unpredictability in
mind.
§ Harness the collective intelligence of your data and SMEs
§ Build a system that can take advantage of the shared knowledge
that is generated from your user base.
§ Speed matters
§ Real-time performance is not a nice-to-have anymore. Fast
performance allows for pro-active measures.
What we can learn from military intelligence

Questions?
Go’vt CTO
MarkLogic
Chris Biow
Digital Media Specialist
MarkLogic
Diane Burley
Principal Technologist
MarkLogic
Fernando Mesa
Submit questions via Q&A panel …
MarkLogic webcasts are
available online!
www.marklogic.com/webinars

Thank you!
For more information on this webinar:
Chris Biow – Chris.Biow@marklogic.com
Fernando.Mesa – Fernando.Mesa@marklogic.com
Diane Burley – diane.burley@marklogic.com
MarkLogic webcasts are
available online!
www.marklogic.com/webinars

Fraud webinar - Prevention & Risk Management

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